Despite the introduction of UTT, up to half of PLHIV present with advanced HIV disease (AHD), defined for adults and adolescents as a CD4 cell count < 200 cells/μL or a WHO Stage III and IV defining illness.22,23 The WHO 2017 guidelines recommended that a package of screening, prophylaxis, rapid ART initiation, and intensified adherence interventions be offered to PLHIV presenting with AHD.23 The gene discussed is CD4; the disease is mitochondrial DNA depletion syndrome 4a.